Veterans deserve better than the Department of Veterans Affairs current advance care planning tool

Paul Malley, President of the national non-profit organization Aging with Dignity, said the nation's 24 million veterans deserve better than the Department of Veterans Affairs current advance care planning tool, "Your Life, Your Choices."

"'Your Life, Your Choices' encourages our nation's service men and women to look at illness and disability as things that render life not worth living," Malley said. "This fuels suspicion and uneasiness about advance directives, and rightly so."

Malley echoed the concerns of Aging with Dignity founder Jim Towey whose guest commentary published in the August 19th Wall Street Journal takes the VA to task for trying to "push poll" vets into choosing to forego treatment that could benefit them. "Your Life, Your Choices" lists several scenarios such as living in a nursing home, being in a wheelchair, or being unable to "shake the blues" and then asks users to determine whether that would make their life "not worth living." Overt appeals to one's sense of guilt over "being a burden" are numerous in "Your Life, Your Choices" and are contrary to a society that values people as a gift and not a burden.

In December 2007, Malley was named as one of a panel of 18 invited by the VA to review "Your Life, Your Choices." He had earlier expressed his concerns about the biased nature of the document and its listing of the Hemlock Society (now called "Compassion and Choices") as a resource. All versions of "Your Life, Your Choices" were removed from circulation, but now it is back in official use. "Steering people in any direction does a disservice both to our nation's veterans and their families and to the larger cause of good advance care planning," Malley said.

"Aging with Dignity was founded on the principle that each person's dignity is to be respected and protected, particularly in times of serious illness or near the end of life," Malley said. "We've long rejected the idea that medical decisions should be based on a person's abilities or disabilities. These decisions surely should not be directed by a 50-page book that focuses, among other things, on 'what it means to be a vegetable.'"

Aging with Dignity is the creator and distributor of the Five Wishes advance directive, the closest thing in America there is to a national advance directive. Some 13 million copies of Five Wishes are in national circulation, distributed by 15,000 partner organizations. Five Wishes is available in 23 languages and allows users to state in their own words what kind of life support treatment they want or don't want in case of serious illness. The document is easy to use and also speaks to personal, family and spiritual issues - the things people say matter most to them.

"The best advance directives are neutral in that they don't aim you one way or another," Malley said. "They should empower you and affirm your intrinsic self-worth."